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Introduction to Health Policy

Introduction to Health Policy. Nathaniel Schlicher, MD, JD Legislative Advisor Emergency Medicine Residents’ Association Emergency Medicine Resident Wright State University Attorney at law Johnson, Graffe , Keay , Moniz & Wick, LLP. Why Are You Here?. Maybe… Cool Location

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Introduction to Health Policy

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  1. Introduction to Health Policy Nathaniel Schlicher, MD, JD Legislative Advisor Emergency Medicine Residents’ Association Emergency Medicine Resident Wright State University Attorney at lawJohnson, Graffe, Keay, Moniz & Wick, LLP

  2. Why Are You Here? • Maybe… • Cool Location • Meet and Greet • Program Paid For it • Or Maybe… • Want to Make a Difference • Want to Guide Change • Care about an issue

  3. History of this Program Where We Were • Resident Focused Track • Chair’s Challenge • Social Reception to Meet the Leaders What We Have Added • Added First-Timers from YPS Section of ACEP • Integrated Media Training • Roundtable discussions

  4. Today’s Speakers • 1:00 – 1:40 Introduction • Nathaniel Schlicher, MD, JD • 1:40 – 2:20 Health Care Economics • James Eadie, MD, FACEP • 2:20 – 3:00 Current Issues • Jennifer Wiler, MD, MBA

  5. Afternoon Agenda • 3:00 – 4:00 Roundtable Discussion • 10 Hot Topics • 4:00 – 6:00 Media Training • Speakers Bureau Pre-Requisite • 6:15 – 7:15 Reception • Cocktails and Networking

  6. Objectives • What is Advocacy? • Legislative Process • Health Care Reform • Medical Malpractice Reform • Getting Involved

  7. Advocacy = Politics

  8. Advocacy is… speaking for a cause, often for a vulnerable person

  9. US!

  10. What is Advocacy to You? • Calling Consultants • Getting that Test • Free Care for All • Hospital Boards • Medical Staff Meetings • Overcrowding Solutions • State Laws • Regulations • Federal Policy • Reimbursement

  11. Why should we care? EMTALA

  12. $138,300 / year per ER Physician $12, 300 / year Average Physician

  13. On call Specialists Medical Home CLOSED

  14. We Need a Seat at this Table! • President Obama’s Health Reform Summit

  15. Now Do you Care?

  16. The Legislative Process

  17. The Start • Bill is Introduced • Referred to Committee • Referred to a Subcommittee • Bart Gordon (HR 1188) • Energy and Commerce • Ways and Means • Subcommittee On Health in both Committees

  18. The Hearings • Subcommittee Hearings • Report out or Table it • Committee Hearings • Report out or Table it • Full Chamber Considers • Approve, Defeat, Refer Back, or Table it • Second House Consideration

  19. The Home Stretch • Compromise • Amendments referred back to original chamber • Conference committee • Presidential Consideration • Sign • Veto • No Action Pass • Pocket Veto

  20. Health Care Reform

  21. The Rationale • 46 million uninsured • 1 in 3 Americans under 65 without health insurance in 2007/2008 • Bankruptcy every 30 seconds from medical costs • 72% of Americans favor increasing government control on costs

  22. Obama Campaign Plan • EHR 10 billion over 5 years • Increased Prevention • Align incentives for excellence – PQRI • Malpractice insurer reform • Competitive Insurance • National Health Ins. Exch. • SCHIP Expansion • Eliminate Medicare Advantage • Negotiate Drug Prices • Tax Credits

  23. Moments of Pause • Expanded Pay for Performance • SGR like cuts are likely • More Medicaid or Medicare unclear • Decrease specialist utilization via incentives

  24. Funding the Plan • Stimulus Bill • 17 billion for EHR • 60% subsidy for COBRA • 87 billion for 2 years of Medicaid • 50-65 billion / year via • Tax cut rollbacks on >$250,000 • Keep the Estate Tax • 634 billion over 10 years • Reduced deductions • Medicare Advantage gone • Provider cuts

  25. The Wrinkle Cost: $1.5 Trillion / 10 years Areas of Savings: Physicians Hospitals Insurers Drug Companies

  26. Hope and Change • Allocation for SGR Reversal in 10 year plan • “Restructuring” of payments to physicians • Can We Get a Bailout?

  27. Tort Reform

  28. Why? • Insurance Premiums • $26 billion annually • 12% / year growth rate • Cases more expensive • 52% exceed 1 million • Average verdict 4.7M • Defensive Medicine?? • $70-124 billion estimates

  29. What are the issues? • Malpractice Caps • Statute of Limitations • Statute of Repose • Attorney Fee Limits • Expert Witness Qualifications

  30. Where We Stand

  31. http://www.atra.org/files.cgi/8291_Record_12-08.pdf

  32. Data from the CBO (2004) • Caps improved costs • Decreased costs of health insurance • Decreased cost of malpractice coverage • Increased insurance premiums • Increased physicians • Collateral Source Reform • Limited decline

  33. Many Issues Remain • State or Federal Issue? • Clumping of tort reform • Stigma of greed • Powerful Plaintiff Bar

  34. Getting Involved

  35. EMRA • 35th year of existence • 8457 Members • 33% of all ACEP • Health Policy Committee • Legislative Advisor • Advocacy Handbook

  36. ACEP Projects • 911 Network • Speakers Bureau • Access to Emergency Medical Services Act of 2009 • S. 468 / H.R. 1188 • Jen Wiler

  37. ACEP Committees • Federal Governmental Affairs Committee • State Legislative / Regulatory Committee • Medical-Legal Committee

  38. NEMPAC • Election Cycle 2 years • 2 million dollar goal • Ranking • 1 – Anesthesiology (3.12M) • 2 – Orthopaedics (2.37M) • 3 – Radiology (1.70M) • 4 – Ophthamology (1.69M) • 5 – Emergency Med (1.68M) • Give-a-shift Goal • $1000 / attending • $100 / resident

  39. You May Be Involved But… • Rally your group / residency / friends • Give a Lecture / Journal Club on Advocacy • Become a Spokesperson • Give your Time and Money

  40. Want More Information? 2009 EMRA Advocacy Handbook

  41. Thank Yous • Anthony Foianini, MD, • Maine Medical Center, Portland, ME • Christopher S. Jones, MD • Eastern Virginia Medical School, Norfolk, VA • Eric Goralnick, MD • Yale New Haven, New Haven, CT • Daniel Freess, MD • University of Connecticut, Farmington, CT • George Leach MD • Emory University, Atlanta, GA • Edwin F. Lopez, MD • Sinai-Grace Hospital, Wayne State University, Detroit, MI • Chet Schrader, MD • Washington University in St. Louis, St. Louis, MO • Michael Dorrity, MD • MSU-Sparrow Hospital, Lansing, MI • Erin E. Schneider, MD • Oregon Health and Science University, Portland, OR

  42. Thank Yous • Kaedrea Jackson, MD, MPH • SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY • Malika Fair MD, MPH • Carolinas Medical Center, Charlotte, NC • Stephen Tantama, MD • Naval Medical Center San Diego, San Diego, CA • Thomas Masters, MD • Wright State University, Kettering, OH • Jamie “Akiva” Kahn, MA, MSIV • University of California at Irvine, Irvine, CA • Marisa L Oishi, MD • Mount Sinai School of Medicine, New York, NY • JawadKassem, MD • SUNY Upstate Medical University, Syracuse, NY • Yogin Patel, MD, MBA • Apollo MD, Atlanta, GA

  43. Upcoming Advocacy Events • Advocacy Webinar – May 21st at 2pm EST • Target Audience – Junior Faculty • Speakers – Nathan Schlicher and Gordon Wheeler • ACEP Blog: • Thecentralline.org • Rotating Bloggers • Twittering with LAC • Emresidents • LAC09

  44. Take Away Points • Advocacy is a core competency for us • Get involved, we need you! • Medical Malpractice Liability Reform may live • Health Care Reform Details Coming Soon! • Stay involved

  45. Thank you!

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